Hi, everybody:

I would like to know if these two medications, Tambocor and Inderal, can cause heart attacks and/or strokes, whether or not they are taken together.

The amounts and dosages of these two medications I take are:
-Tambocor (flecaïnide) extended release 200 mg: one capsule daily
-Inderal (propranolol) immediate release 40 mg: one tablet twice daily

I also take other medications (Duragesic, MSIR, Tylenol, Keppra, Klonopin, etc.) but my question is about these two medications specifically (Tambocor and Inderal).

Thanks for your information.

According to drug checker:

http://www.drugs.com/interactions-ch...1266,1094-2330

In general drugs like Tambocor do carry some risk for certain people:

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000466/

Do not change doses, or suddenly discontinue either medication without medical supervision. This is very important.

Hi, mrsD and others:

Thanks for the links and information.

Quote: "MONITOR: Beta-blockers and flecainide may have additive negative inotropic effects. Areas under the curve were increased for both drugs and negative inotropic effects occurred when flecainide and propranolol were given to normal subjects. A case of bradycardia, atrioventricular block and cardiac arrest has been reported after sotalol was added to flecainide; however, causality was not definitely determined."

I cannot find the word "inotropic" in my dictionary and, as a result, I do not know what this word means. If there was a health care professional here (doctor, nurse...) who could give me not only the definition of this word, but also the meaning of "Areas under the curve were increased for both drugs."

There is information about a cardiac arrest, bradycardia (slow heart beat), and block (?) with the mix of flecaïnide and sotalol. I wish so hard this would not apply to me because I do not take sotalol, but propranolol.

My cardiologist prescribed the flecaïnide for me, but he does not know I take the propranolol. The propranolol was prescribed for me, after the flecaïnide, by my primary care physician. This doctor does know I take flecaïnide.

I feel caught between a rock and a hard place. On the one hand, the mix of these medications might be dangerous, even deadly; on the other hand, I need these medications for the control of my intense RSD pain, because the fentanyl patches and morphine capsules do not seem to be as effective as they used to be. I really do not know what to do. I am almost 100% sure my primary care physician will not increase the dosage of the fentanyl patches. There is no qualified pain management doctor where I live.

Quote: "MANAGEMENT: Careful monitoring of the patient's hemodynamic status is recommended during concomitant administration. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Patients should be advised to promptly report symptoms such as dizziness, slow or irregular heartbeats, syncope, or palpitations."

Another word I do not find in my dictionary is "hemodynamic". What are exactly "palpitations"? I know this word is commonly heard, but I am not sure I understood it right.

Quote: "Do not change doses, or suddenly discontinue either medication without medical supervision. This is very important." Thanks for warning me, mrsD. I really appreciate the information.

inotropic:
http://www.thefreedictionary.com/inotropic

Affecting the heart muscle and its ability to contract.

Hemodynamic means blood flow. Drugs that reduce contraction of the heart, or slow the beats result in slower blood flow over all.

Sotalol was the betablocker that was reported in that interaction.
It is similar to the one you take. (all beta blockers are similar, with some being cardioselective and others not...propranolol is not considered cardioselective, meaning it affects larger areas of the body as well as the heart.)

You should notify the cardiologist ASAP that another doctor is also prescribing drug(s) for you, as this may impact the heart.
A patient should always keep all doctors in the loop regarding addition or subtraction of drugs.

Bradycardia is a slowing of the heart beat.

Suffice it to say, at this point you should be talking to your cardiologist and follow his/her recommendations IMO.

Hi, mrsD:

Thanks for giving me the link to the free medical dictionary and thanks for the medical words definitions. I thought the definitions of these words could be found in a medical dictionary, but I did not have access to such a dictionary, in a paper version or in an online version.

Quote: "Hemodynamic means blood flow. Drugs that reduce contraction of the heart, or slow the beats result in slower blood flow over all." I hope I will not get a blood clot because of slower blood flow.

In the past, my father had a blood clot in one of his legs; this clot moved to his brain and caused him to have a stroke, which affected his talking. Now, another blod clot has just returned in one of his legs again.

I hope the same thing will not happen to me. I am thinking of what would become of my two-year-old baby boy if I had a blood clot that moved to my brain and killed or disabled me enough so that I could not take care of a child. I do not want CPS stealing him.

When you say that propranolol is not a cardio-selective beta-blocker and that it "affects larger areas of the body as well as the heart", what could propranolol do to these areas of the body other than the heart?

I thought about notifying my cardiologist that I am taking propranolol besides taking flecaïnide, but I am so afraid my cardiologist will call my primary care doctor to tell him not to prescribe the propranolol for me anymore. I already had such a hard time convincing my primary care physician to prescribe a beta-blocker for my RSD pain.

What would happen with my RSD pain without either the flecaïnide or the propranolol? Like I said, my Duragesic and MSIR do not seem to be as effective as they used to be (due to tolerance?), so I am relying on the flecaïnide and the propranolol to boost and potentiate the pain killing effects of Duragesic and MSIR. I am already taking my Duragesic at a dosage of 125 mcg (one 100 mcg patch and one 25 mcg patch every 72 hours), so I do not think my primary care doctor will be willing to increase the dosage of my Duragesic to 150 mcg, especially considering the fact that this doctor has already been, in the past, harassed several times by the public health insurance company, which was complaining about the Duragesic costing them too much money.

So I do not know what to do. If you are a RSD pain patient or if you have seen the McGill Pain Scale, you will understand how painful of a syndrome RSD is. If my Duragesic and MSIR continue losing some effect, they will end up becoming totally ineffective, which would be a catastrophe for me. I cannot live with a pain of 10+ 24 hours a day, 365 days a year.

I wish there would be a medication that could protect my heart while I am taking the flecaïnide and the propranolol. This medication only exists in my dreams!

Thanks for caring so much because you took the time to give me all this information. I really appreciate your caring.

Selective betablockers cause less brain involvement. Example is atenolol. It was designed for controlling blood pressure mostly, and anxiety.

The non-selective ones, go into the brain, and typically cause depression and amnesia. Propranolol for example is being looked at for Post Traumatic Stress disorder. It is not surprising therefore that propranolol was chosen for you, because it works all over the body, and not mostly on the heart. But it still affects the heart like the selective ones do.

I cannot answer your RSD question. That is for the experts. sorry.

I really think you should talk to your cardiologist. He/she would understand what to do for you better than an internist.

Hi, mrsD:

I saw the picture of your cat and the comment you added under it. Like you, my family has cats.

My Siamese cat (male) died in 1997 from generalized bone cancer, caused by a certain kind of vaccine, whose name I do not remember. Another one of my father's cats (male) also died from the same type of cancer, caused by the same kind of vaccine. I will admit without shame I do HATE these vaccine manufacturers and veterinarians for having killed these cats, whom I loved dearly, as if they were my children. I saw several documents on the Internet, from veterinarian journals, stating that certain types of vaccines, for cats or dogs, can cause cancer in these animals and kill them. Besides that, I know a woman, whose three Doberman dogs died from the same type of cancer, caused by the same kind of vaccine. I am not usually against vaccines, but in the future, none of my cats will receive vaccines. I strongly believe any animals deserve to live a long and happy life, not shortened by vaccines. Besides that, these animals, who suffered from cancer (or other fatal diseases) must have suffered so much before dying. These animals depend upon us and it is our duty to protect them and give them a happy life as much as we can. When I think about my dead cats, I want to cry again and again. Even if my cats are not physically alive, they will always live in my heart. Thinking about my dead cats, this saying consoles me somewhat: "Even in death, true love never ends." I also like this saying of my own: "One less living being on Earth (human, animal), one more star in the sky."

If your cat cannot be saved, I sincerely hope she has a death as swift and painless as possible. At least, your cat will have had a happy life with someone as loving as you. I can tell you care about her a lot. I am absolutely sure she knows you love her and did everything you could to save her and, before she got ill, to give her a happy life just like she deserves.

Thank you, for your nice comments.

There is a cancer called vaccination sarcoma. In the US there is a new vaccine for rabies called PureVax. It has no adjuvants, and these adjuvants are thought to be the causes of vaccine induced cancers. I don't get any other vaccines for our cats because of this. Feline leukemia is really not common here anymore so not getting it is not a risk.

I only get that vaccine now for my cats. But Oreo did have the old 3 yr rabies one last time, as PureVax is rather new and not all vets use it, yet. Weezie our new kitten has had the PureVax in June, first time. It is a yearly shot, but is supposed to be much safer for the cat. Tippy who died in January at age 20, had two serious vaccine reactions, to the old type. So I am loath to use those anymore. She died of a blood clot...not cancer.

http://docs.google.com/viewer?a=v&q=...KllwhVHoX1O9ig

When researching Oreo's uncommon cancer, I found references that Siamese cats and Rex are more commonly afflicted with mast cell tumors. Oreo's is in her small intestine...with lymph node involvement. So surgery (as pushed by the cat vet)--is not really a good prognosis for her. She still looks normal, but a bit underweight. The new vet (my 4th in 4 weeks) is doing a pulsed steroid treatment and we go back in 2-3 wks to see if the tumors are shrinking or at least not growing larger. He said we may stave off the end this way, and keep her comfortable instead. She is running around outside and enjoying our fall so far. With that time bomb clicking inside! I have to give Benadryl too since she seems nauseous and gags in the wee hours without it. The Benadryl is very bitter and hard to give tho. I am using a transdermal gel to rub on her ear for it. It does help with the vomiting/gagging, as it blocks the histamine that the tumor is releasing into her body.

It has been a sad difficult 4 weeks for all of us. She is not liking me much anymore because I take her to the doctor where all the needles are, and then give her medicine which she hates. So much of my day is "making up" to her with special food treats etc.

Losing pets is like losing a child. They are so innocent and depend on us and give unconditional love in return. ... I know how heartbreaking it has been for you. Our old Sheba 24 died in Oct 2010 and Tippy 20 in early Jan 2011. I have pictures of them in my album still. They were great cats! We get very close to our cats emotionally. I think we have special bonds with each one.

Hi, msrD:

Thank you so much for your information and links. It helps me understand many things, including why my beloved and loving treasures are not here anymore.

Hopefully, PureVax (for rabies) is available in my area; otherwise, none of my cats will get any vaccines. When the veterinarian insists on vaccinating my cats, I refuse to give him the permission to do this and I tell him I want my cats to have a longer and happier life, instead of being killed by a vaccine. He looks at me as if I am crazy, so I am shopping for a new veterinarian.

When humans die because of a vaccine, everyone cares, but when animals (cats, dogs...) die because of a vaccine, no one seems to care, so animals vaccine manufacturers will not make any effort to make safer vaccines for our beloved pets.

My U.S. physical therapist always confides in me when one of her cats dies. She never confides in her work colleagues (physical therapists, nurses, and doctors) because she feels they cannot understand her. Instead, they tell her something like: "Do not cry!!! It is just a cat, not a human!!! Why do you cry just for a cat!!!" Hearing this hurts her feelings sooo much, which I can understand, because I was told the exact same thing when I cried after the death of my cats. To me, these cats are more than friends; they are like family members and, I am not ashamed to say it, like humans. In today's world, there are so many lonely people (especially among old people and single people) that animals are like family to them. They give them the love they lack in their life, which is not something to be dismissed.

Quote: "There is a cancer called vaccination sarcoma." This is certainly what killed my cats and the animals of many other people.

Apart from the rabies vaccine (PureVax), are there, at the present time, other vaccines for other animal diseases that are free of adjuvants?

Quote: "PureVax is rather new and not all vets use it, yet." Is it because they want to use up all their vaccines that contain adjuvants so as not to waste the money they invested in them or is it because they are making more money with these adjuvant containing vaccines (because they may be more expensive than PureVax) or is it because adjuvant vaccines manufacturers are lobbying for them to buy their vaccines instead of buying PureVax?

Your cat Tippy died at age 20 and your cat Sheba at age 24. It is not common for cats to live that long. Of course, Tippy and Sheba might have had "good genes", but I am sure these cats living that long is due to the excellent care you gave them (love, food, exercise...) This shows you truly are a good person. You were so kind to them that these cats wanted to live 20 years or more to stay with a person as loving as you. I am sure Oreo would do that if cancer had not come into her life. All your cats must want to live a long life with you because they know you love them. I read an article in WebMD Cats that says cats do know if they are loved or not by their owners. They can express feelings (happiness, sadness, anger...) according to the good or bad life they have with their owners.

I would sooo much like for a miracle to happen with Oreo so she can continue living with you a long and happy life, which she deserves. I will pray very hard for her. Some stupid people say we should not bother God and pray for animals but I strongly disagree because God loves animals; after all, He created them also. Since animals cannot pray for themselves, why should humans not do it? Once, when I was a kid, my Siamese cat was very sick. Everyone thought he was going to die. I prayed to God to let him live and take me instead. I remember this very well. My Siamese cat did not die, until a veterinarian killed him with a vaccine some years later. I hate him so much! Cat killer!

Quote: "She is not liking me much anymore because I take her to the doctor where all the needles are, and then give her medicine which she hates." I am sure Oreo does not like the veterinarian that hurts her (even if is is involuntary) and the bad-tasting medications you give her. However, I am sure she loves you. The way you talk to her, the way you pet her, all this when you give her her medications, surely make her understand you love her and are trying to help her. I have absolutely no doubt she loves you.

Quote: "Losing pets is like losing a child. They are so innocent and depend on us and give unconditional love in return." This is sooo very true. My cats are my children. If one of my cats has to die from a non-curable disease someday and I know he/she is going to die soon, I call the veterinarian to come urgently at home to give him/her a shot that will send him/her to a better world, with God. I prefer my cats to die at home, with people who love her, rather than in a veterinarian's office, with fear as his/her last thought. Even if it is more expensive to pay for the veterinarian coming home, money is less important than the love we gave each other all these years. For all the love this cat gave during his/her life, I believe he/she deserves to die at home, in an environment he/she knows and loves, with people who love him/her.

Quote: "I know how heartbreaking it has been for you." When I think of my dead cats, even those that died more than a decade ago, I still want to cry my eyes out. I love them sooo much, but there is a part in me that tells myself that I should have done more for them, that I was not good enough.

Thanks for being such a good person to all your cats! They will remember you, wherever they are (certainly with God)!